Formulas · Warm the Interior 溫裏 · Uihak Gangmok (醫學綱目)

Twin Gold Pill

Ssanggeum-hwan

한글 쌍금환 · Pinyin Shuang Jin Wan

雙金丸

The leaf names no drugs of its own: the whole prescription is two other formulas in equal parts, and the ingredient rows above are their constituents, taken from the registered entries for 金液丹 (sulphur) and 靑州白元子 (半夏ㆍ天南星ㆍ白附子ㆍ川烏). The transcription writes 為 for 爲, 沉 for 沈 and 真 for 眞; the corpus forms are printed. The closing source marker is misplaced in the transcription, which opens the citation before 妙劑也 and so reads ≪妙劑也 ○入門≫; the clause belongs to the body text and only 入門 is the label, and it is printed that way here.

Composition 構成

Yuhwang Liu Huang
硫黃 유황 · Sulphur

—
Chief 君

the whole of 金液丹, which is sulphur levigated and calcined for seven days and nights; equal parts with the other pill · toxic
Cheono Chuan Wu
川烏 천오 · Aconite Main Root

—
Deputy 臣

in 靑州白元子 · aconite, toxic
Banha Ban Xia
半夏 반하 · Pinellia

—
Assistant 佐

in 靑州白元子, raw · toxic unless properly processed
Cheonnamseong Tian Nan Xing
天南星 천남성 · Arisaema

—
Assistant 佐

in 靑州白元子, raw · toxic unless properly processed
Baekbuja Bai Fu Zi
白附子 백부자 · Typhonium Rhizome

—
Assistant 佐

in 靑州白元子, raw
Saenggang Sheng Jiang
生薑 생강 · Fresh Ginger

—
Envoy 使

生薑米飮, a ginger and rice drink, as the vehicle the ground powder is poured in with

Total 0 g per packet (첩) · representative dosage — verify against source texts. Excludes 6 ingredients measured by count or used as a vehicle, shown as —.

Received this formula from your practitioner? Amounts shown here are classical reference values — granule and prepared products differ. Always follow your prescribed dosage and directions.

Actions 效能

Treats vomiting and diarrhoea gone on for days, with the spleen and stomach failing, the limbs cold to the elbow and knee, the mind clouded, the child sleeping much with the eyes half open and the breath cold at mouth and nose, on the point of becoming chronic fright wind
Two other pills in equal parts, ground together and poured in with a ginger-and-rice drink
Given in quantity rather than sparingly, on the claim that only a large dose answers

Indications 主治

Pattern-based

慢驚風 — chronic fright wind, here in the stage before it has fully declared itself
吐瀉日久, 脾胃虛損 — protracted vomiting and diarrhoea with the spleen and stomach depleted
手足厥冷, 口鼻氣冷 — the limbs and the breath cold
露睛 — the eyes left half open in sleep

Biomedical correlates

Hypovolaemic shock after prolonged gastroenteritis in a child
Hyponatraemia, hypokalaemia, hypoglycaemia and hypocalcaemia from fluid loss
Seizure secondary to any of those derangements

Source text 原文

Donguibogam 東醫寶鑑

治吐瀉日久, 脾胃虛損, 手足厥冷, 精神昏塞, 多睡露睛, 口鼻氣冷, 欲成慢驚風. <a href='/formulas/geumaek-dan'>金液丹</a><span class='sochu'>方見寒門</span>與<a href='/formulas/cheongju-baegwonja'>靑州白元子</a><span class='sochu'>方見風門</span>等分, 同硏, 生薑米飮調灌之. 惟多服乃效, 雖至危者, 往往死中得生, 十救八九. 沈存中云, 金液丹治吐利垂絶, 服之得活, 須多服方驗. 《綱目》 ○一云, 金液丹眞小兒吐瀉之妙劑也. 《入門》

Translation

Treats vomiting and diarrhoea gone on for days, the spleen and stomach depleted, the hands and feet cold to the joint, the mind clouded and sealed, much sleeping with the eyes half open, the breath cold at mouth and nose, and chronic fright wind about to form. Geumaek-dan 金液丹 — the formula is in the Cold chapter — with Cheongju-baegwonja 靑州白元子 — the formula is in the Wind chapter — in equal parts. Grind them together and pour the mixture in with a ginger and rice drink. Only a large dose answers; even in a child already desperate, life is often got out of death, and eight or nine in ten are saved. Shen Cunzhong says: Geumaek-dan treats vomiting and diarrhoea at the point of extinction, and a child who takes it lives; it must be taken in quantity before it proves itself. — Gangmok 綱目 ○One account says Geumaek-dan is truly the marvellous remedy for vomiting and diarrhoea in children. — Immun 入門 (Donguibogam · Soa)

Clinical commentary 臨床

Two pills bought ready-made and ground together: 金液丹, which is sulphur levigated and then calcined in a luted pot for seven days and nights, and 靑州白元子, a phlegm pill of 半夏ㆍ天南星ㆍ白附子ㆍ川烏 soaked and washed for days before it is made up. The indication is the child who has been vomiting and purging for days and is now cold, drowsy and sinking — the stage the chapter calls 欲成慢驚風, about to become chronic fright wind. The chronic picture this section treats is a depleted child, pale and cold and limp after a long vomiting and diarrhoea, drowsy, the eyes half open in sleep, twitching feebly. That child is not convulsing from a disorder of wind: it is convulsing because something systemic has gone wrong — dehydration with the sodium, potassium and calcium deranged, hypoglycaemia, the encephalopathy of severe malnutrition, or sepsis. The prognosis really was bad, and the text is honest about it. What changed the outcome is not a better formula but fluid and electrolyte replacement: oral rehydration solution, which costs a few cents, with glucose, and intravenous fluid where a child can no longer drink. None of it existed in 1613. What the leaf claims is a cure rate: eight or nine saved in ten. That figure cannot be read as an outcome. Most children with diarrhoea recover whatever is given, and the ones who were dying of it were not going to be turned by sulphur. Shen Cunzhong's remark that the pill has to be taken in quantity before it proves itself is the tell — it is an instruction to keep dosing past the point where nothing is happening. **The patient is a child and the text gives no dose by weight anywhere, only ‘equal parts’ of two pills and an instruction to give a great deal. 靑州白元子 contributes 川烏, aconite, which has almost no margin between an effect and a fatal arrhythmia, and 半夏 and 天南星, which are toxic raw and depend on processing that cannot be verified in a finished pill. The sulphur of 金液丹 is given internally. This must not be prepared.** — Eui Young (Justin) Chung, L.Ac., Dipl. O.M.